TMJ Surgery and Conservative Management

TMJ or Tempromandibular Joint refers to the jaw joints. This term has become synonymous with a range of disease states and can be a source of confusion.

The TMJ is a complex joint that has an interestingly complex set of movements which relate to the unique anatomy. The joint is divided into two Movement of a normal joint and disk compartments which provide both rotation and translation. The majority of rotation takes place in the lower compartment and translation, or movement along a plane, takes place in the upper compartment. Both compartments are filled with a thick lubricating fluid called synovial fluid. The compartments are separated by the disk or meniscus, which absorbs the forces of chewing. Disk movement on a joint that is clicking Clicking will occur as the disk becomes displaced.

Often, no treatment is needed for clicking, but at times it may produce pain and may prevent the smooth travel of the jaw during opening or closing.

Surgery of the disk may be necessary if there is significant degeneration or displacement, which produces intractable pain or inhibits function. Image of a dislocated disk and consequent joint movement The disk may be repositioned, altered in shape and thickness, or removed at surgery. Occasionally, graft materials obtained from other areas of the body may be used to replace the damaged tissue. The joint may be approached by an incision, which is placed just in front of the ear. The incision usually is hard to detect after healing.

TMD or TemproMandibuar Disorder is a loose term that applies to a range of problems including the internal derangement described above and muscle function and muscle spasm disorders. Some of the disorders are related to bruxism or teeth clenching, which fatigues the muscles and may injure the teeth and TMJ. Often, a bite splint may diminish pain and improve function in a dramatic way. Some patients will benefit from orthodontics to correct tooth position or dentistry to replace loose and ill-fitting partial and full dentures.

Poor relationship of the jaws, especially a short lower jaw, will cause stress to the joints and muscles. Patients with a significant defect may benefit from surgery to lengthen the jaw. With the help of Orthodontists to align the teeth, the surgery will correct not only the position of the teeth for better function, but will reduce the stress on the TMJ and associated muscles. Please see the section on Orthognathic Surgery.